Treatment for Pediatric Anxiety: Falling Short

Posted on February 20, 2014 at 8:20 pm

A study completed by John Hopkins University School of Medicine in Baltimore, Maryland, the longest follow-up study of pediatric anxiety disorders, has published its results.[1] The researchers found that fewer that 50 percent of children who initially responded to acute treatment actually achieve long-term symptom relief.1

While those who showed clinically meaningful improvement after 12 weeks of treatment were more likely to achieve remission compared with those who showed minimal or no initial clinical improvement, relapse occurred in 48 percent of responders.1 Therefore, there is a need for more research regarding more intensive or continued treatment within this population.1

“The good news is that about half of the kids were disease free, and those who improved during the initial treatment period were less likely to have an anxiety disorder at follow up,” said lead author Golda S. Ginsburg, Ph.D. “But the flip side is: how do we help the other 50 percent who continue to struggle with anxiety? I think the take-home message is that we may need better treatments, and three months of treatment is probably not long enough.”1

Anxiety disorders are the most common psychiatric illnesses in children, and are considered “gateway disorders” that may lead to adult psychiatric problems, such as depression and substance use.1 However, data on long-term treatment outcomes for children with anxiety disorders are lacking.1 In fact no other study has compared the long-term outcomes of cognitive-behavioral therapy with those of medicine or combined treatment.1

Ginsburg and colleagues report that specific treatment condition was not associated with any significant outcome in their study.1 A total of 51.9 percent of the medication group were in remission at follow-up, as well as 48.8 percent of the combination treatment group, and 45.8 percent of the cognitive-behavioral therapy group.1

In fact, higher functioning was only predicted by fewer negative life events, the absence of comorbid disorders, and the absence of interim medication and/or therapy use.1 These factors can help predict who is at a higher risk of relapse, which can also help develop new treatments to target specific risk factors.1

Assistant Professor at the Yale Child Study Center, Eli R. Lebowitz, Ph.D., said “I’d say this is a really important study. The truth of the matter is that long-term outcomes for childhood anxiety treatment are a little bit of a black hole, give out current state of knowledge. There’s actually not been a lot of research on this kind of long-term outcomes. There have been 3-, 6-, and maybe 12-moth follow-ups, but it’s pretty rare to see anyone follow up at this length of six years. So this was an important undertaking.”1

This study has raised the bar higher for further research regarding pediatric anxiety disorders.1